Transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the management of portal hypertension

The transjugular intrahepatic portosystemic stent-shunt (TIPSS) is a non-surgical side-to-side portocaval shunt inserted by radiological techniques. It can be successfully performed in over 90% patients, many of whom would be too ill for surgery. TIPSS has an established role as rescue procedure in acute variceal haemorrhage refractory to endoscopic therapy and for recurrent oesophageal variceal haemorrhage. It is also indicated in bleeding from gastric and ectopic varices and severe portal hypertensive gastropathy and has been used to treat Budd-Chiari syndrome and cirrhotic hydrothorax. The exact role of TIPSS in managing patients with refractory ascites and hepatorenal syndrome remains to be determined. Rates of shunt insufficiency increase with duration of follow-up and occur in approximately 33-60% at one year. Regular and long-term shunt surveillance is therefore required. Variceal rebleeding occurs in 6-19% patients following TIPSS insertion and is almost invariably associated with shunt dysfunction. Procedure related encephalopathy affects 10-30% patients during follow-up but is generally easy to manage with simple medical measures. Further controlled trials will clarify its exact role in managing patients with portal hypertension and development of covered stents should improve shunt patency